Master Claim Itemization Table Instructions

The Master Claim Itemization Table is to be completed and submitted with your Proof of Claim form, which will be provided by the Receiver. This table should not be completed before you have received a Proof of Claim form.

Note: The instructions below do not allow a claimant to file a claim against an open receivership. Instead, these instructions provide guidance on completing a master claim itemization table which is a supplemental filing for a claimant with multiple invoices who is in the process of completing and submitting a proof of claim form issued by the Receiver.

If you need guidance on the claim filing process for a specific receivership, please review the frequently asked questions ("FAQ's") for that individual receivership. For a listing of receiverships, please click here.

The Division of Rehabilitation and Liquidation ("Receiver") has developed various Master Claim Itemization Tables to assist medical providers, agents and other general creditor claimants that have provided multiple goods or services to a company in receivership and thus have multiple invoices. In these situations, such a claimant files one claim and all their invoices equal the total amount of their claim.

The Master Claim Itemization Tables take into consideration whether the claimant is a medical provider, claims vendor or other type of general creditor. If you are a medical provider that has multiple invoices for medical goods and services provided, please click on the Medical Provider Master Claim Instructions link below. If you provided claims services on multiple files, please click on the Claims Vendor Master Claim Instructions link. If you are another claimant type who has multiple invoices for monies owed to you, or you would typically have multiple invoices and have only one to submit at this time, please click on the All Other General Creditor Master Claim Instructions link below. Claims submitted in a format other than what is specified may delay evaluation of your claim(s), result in the rejection of your claim in its entirety and/or offset against your claim of any administrative costs incurred.

Please keep copies of the documentation you submit to the Receiver along with your proof of claim form. If a distribution is made, we will not be able to provide you with detailed information on the individual claims you submitted.

• Medical Provider Master Claim Instructions - for medical providers only.



• Claims Vendor Master Claim Instructions – for vendors who provided services related to claims handling only (appraisers, adjusters, defense attorneys, etc.)



• All Other General Creditor Master Claim Instructions – for all other vendors who provided services on multiple policies (agents, premium finance companies, etc.).